Epilepsy is among the most common neurological disorders in childhood and has been increasingly associated with cardiovascular dysfunction. Speckle tracking echocardiography (STE) has emerged as a sensitive imaging modality capable of detecting latent left ventricular impairment before overt cardiac disease develops. This systematic review synthesized the available evidence regarding myocardial strain alterations and subclinical left ventricular dysfunction in pediatric patients with epilepsy assessed by STE. Following PRISMA 2020 standards, comprehensive searches were conducted in PubMed, Scopus, and Web of Science for studies including children with epilepsy evaluated by STE, regardless of control group inclusion. Data on conventional echocardiographic indices and myocardial strain parameters were systematically extracted and analyzed. Fifteen studies met the eligibility criteria. Conventional echocardiographic parameters were consistently normal across all reports, whereas STE uniformly demonstrated reduced global longitudinal strain and apical strain among epileptic cohorts. The degree of strain reduction correlated with epilepsy duration, seizure control, and exposure to antiseizure medications, while tissue Doppler imaging revealed concomitant abnormalities in early systolic and diastolic function. These findings indicate the presence of subclinical left ventricular dysfunction in pediatric epilepsy, detectable only through STE. This technique provides a sensitive and reproducible method for identifying early myocardial impairment, supporting its potential role in risk stratification, longitudinal monitoring, and prevention of future cardiovascular complications in this population.